Risk factors for Non-Hodgkin's lymphoma in autoimmune disease: a large database analysis.

Immune dysregulation in autoimmune diseases (ADs) is a risk factor for the development of Non-Hodgkin's lymphoma (NHL). However, the underlying mechanisms are not well understood. Hence, this retrospective study aims to describe the clinical and demographic factors that increase the risk of NHL development in patients with ADs. Our study utilised data from National Inpatient Sample (NIS) for the duration of 2016-2020 on all adult patients aged > 18 years who had NHL. We divided them into two cohorts: one with underlying ADs and one without underlying ADs. We then compared the adjusted odds ratios (aOR) of various risk factors. It was found that 0.9% of autoimmune cases had NHL, while 0.7% of non-autoimmune cases had NHL. Among those with autoimmune conditions, various factors influenced the presence of lymphoma, such as personal history of chemotherapy or radiation, family history of lymphoid malignancy, HIV infection, advanced age of 60-69 years, Asian and Pacific Islander ethnicity and viral hepatitis. The increased risk of NHL with autoimmune conditions is well established. Studies have also shown that these patients can overall have a poor prognosis from their NHL when compared to patients without autoimmune diseases. However, there is limited literature regarding the interplay of traditional NHL risk factors with underlying autoimmunity. Hence, our study sheds light on the lesser studied risk factors, such as patient characteristics and comorbidities.

A Rare Case of Anti-TIF-1γ Antibody Positive Dermatomyositis in Adulthood.

Dermatomyositis (DM) presents with inflammatory myopathy and distinct skin manifestations, often linked to specific autoantibodies. Anti-transcriptional intermediary factor-1 gamma (TIF-1γ) antibodies (Abs) are typically linked to DM in older patients and malignancy in 15% to 40% of cases. We highlight a case of a 24-year-old female who presented with weakness of proximal muscles, periorbital edema, heliotrope rash, erosions on oral mucosa, and painful scaly rash on the lower extremities. Transcriptional intermediary factor-1 gamma Abs were positive, confirming inflammatory myopathy. Treatment with steroid pulse therapy and immunoglobulin led to improvement. Evaluation for malignancy yielded unremarkable results. This case underscores the importance of recognizing and managing DM with TIF-1γ Ab positive, even in atypical demographics, and highlights the need for comprehensive malignancy evaluation.

An Unusual Presentation of Membranous Nephropathy in an Adult With Arthrogryposis: A Case Report.

Membranous nephropathy (MN) is an autoimmune condition that is a common cause of nephrotic syndrome in nondiabetic adults. In this study, we highlight a case of a 22-year-old male with a past medical history of arthrogryposis multiplex congenita (AMC) who initially presented with right flank pain and hematuria. Subsequent workup revealed significant proteinuria with biopsy-proven primary MN. Early detection of the disease is critical to establish treatment promptly and prevent complications such as those resulting from a hypercoagulable state.

Primary Pancreatic Undifferentiated Pleomorphic Sarcoma.

Primary pancreatic sarcomas are rare malignancies with an incidence of 0.1%. This case report is of a 48-year-old man who presented with this condition. The patient's treatment plan consisted of distal pancreatectomy and splenectomy with intraoperative immunohistochemistry and adjuvant chemotherapy. To correctly identify and treat undifferentiated pleomorphic sarcoma, a stepwise strategy involving cross-sectional imaging and extensive histopathology analysis is necessary.

Bowel ischemia in COVID-19: A systematic review.

BACKGROUND: Gastrointestinal complications of COVID-19 have been reported over the last year. One such manifestation is bowel ischaemia. This study thus aims to provide a more holistic review of our current understanding of COVID-19-induced bowel ischaemia. METHOD AND RESULTS: A meticulous search was performed using different keywords in PubMed and Google Scholar. Fifty-two articles were included in our study after applying inclusion and exclusion criteria and performing the qualitative assessment of the studies. A total of 25 702 patients were included in our study after the completion of the qualitative assessment. DISCUSSION: The common symptoms of GIT in COVID-19 patients are as diarrhoea, vomiting, nausea and abdominal pain. The mechanism of bowel ischaemia is associated with the formation of emboli which is related to COVID-19's high affinity for angiotensin-converting enzyme-2 on enterocytes, affecting the superior mesenteric vessels. Clinically, patients present with abdominal pain and vomiting. CT angiography of the abdomen and pelvis showed acute intestinal ischaemia (mesenteric). Management is usually initiated with gastric decompression, fluid resuscitation, and haemodynamic support. Surgical intervention is also sought. CONCLUSION: Intestinal ischaemia presenting in patients with COVID-19 has to be considered when symptoms of severe abdominal pain are present. More research and guidelines are required to triage patients with COVID-19 to suspect intestinal ischaemia and to help in diagnosis and management.

Clostridioides difficile co-infection with Enterohemorrhagic Escherichia coli (EHEC)-a potentially fatal combination.

There has been a significant increase in hospital and community acquired Clostridioides difficile infection in the past decade. In addition to CDI, the rate of infection with enterohemorrhagic Escherichia coli (EHEC) has also increased by 28% in United States in the last five years. Concomitant CDI and EHEC infections are rare and if not identified early such co-infections can be fatal. We present the case of patient with hematochezia who was found to be positive for Clostridioides difficile and EHEC. She had a complicated hospital course that required timely identification of complications and management.

Resource husbandry in challenging times.

Coronavirus disease 2019 (COVID-19) pandemic has put a huge pressure on healthcare systems across the globe, more so in developing countries. Not only patients of acute febrile illness and respiratory problems but also patients with other acute and chronic diseases are facing challenges while seeking healthcare, getting laboratory investigations done and obtaining medications. Healthcare workers have their challenges including limited resources, lack of personal protective equipments, and fear of contracting COVID-19. Resource husbandry, which refers to the judicious use of available stocks, is a vital concept that needs to be promoted during such challenging times to combat the shortage of medical resources while simultaneously providing effective treatment to the patients. Some easily implementable concepts of resource husbandry can have a significant impact and result in minimising trouble for many patients during a challenging time.

Intractable Vomiting and Hiccups: An Atypical Presentation of Neuromyelitis Optica.

Neuromyelitis optica is an inflammatory disorder of the central nervous system. It involves the immune-mediated demyelination of predominantly the optic nerves and the spinal cord, which can lead to optic neuritis and transverse myelitis, respectively. Patients usually present with symptoms related to the eyes or the spinal cord, like loss of vision, pain in the eyes, visual field defects or numbness and weakness of limbs. Vomiting and hiccups are common cases encountered in medicine clinics and can sometimes be an atypical presentation of this disorder. Here we present a case of a 33-year-old female who initially presented to our tertiary care centre with repeated episodes of bilious vomiting and intractable hiccups for 10 days. After multiple investigations over a couple of days, the patient was found to be positive for anti-NMO antibodies and displayed neuro-radiological findings on MRI brain and spine, which finally led to the diagnosis of neuromyelitis optica spectrum disorder (NMOSD). Through this case we highlight the importance of suspecting NMO in a patient with complaints of intractable vomiting and hiccups, so that early intervention and treatment can prevent further disabling complications of the disease.

Abiotrophia defectiva: A Rare but Critical Cause of Infective Endocarditis.

Infective endocarditis (IE) refers to an infection involving the endocardial surface of the heart. Most of the cases of IE are known to occur due to infection by viridans Streptococci or Staphylococci species. Abiotrophia defectiva is known to cause less than 1% of cases of IE. Though rare, this organism can cause life-threatening complications such as septic embolization, destruction of heart valves, and heart failure if not detected and treated timely. Here we discuss a case of a 44-year-old female who presented to our tertiary care centre with complaints of fever and easy fatiguability for two weeks. After further investigations, she was finally diagnosed to have IE due to Abiotrophia defectiva. Imaging demonstrated the presence of embolic and valvular complications as well. Through this case, we highlight the importance of early detection and timely management of this condition in order to decrease the occurrence of fatal complications and mortality.

Awareness of Patients' Rights among Inpatients of a Tertiary Care Teaching Hospital- A Cross-sectional Study.

INTRODUCTION: The rights of a patient are a set of rules of conduct which govern the interaction between the patients' and healthcare professionals. Every patient has a right to be informed about their rights and also the responsibility of the healthcare provider. AIM: To assess awareness among inpatient about patients' rights at an academic accredited hospital. MATERIALS AND METHODS: A questionnaire based cross-sectional study was carried out among 350 patients admitted to the wards of a Tertiary Care Teaching Hospital. A 21-point questionnaire was developed based on standards of the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and patients' charter of rights and validated. This charter of rights is also displayed in the hospital for patient's awareness. Frequencies and percentages were depicted. Chi-square test was used for statistical analysis. RESULTS: Positive awareness among the patients ranged from 28% to 97.4%. Females were more aware of their rights than males for 11 out of the 21 patient rights items. Younger adults were more aware than any other age group participants. Participants who were admitted to wards of higher categories (deluxe rooms) had high degree of awareness about patients' rights and education. Patients from urban areas and higher educational status were more aware than patients coming from rural areas. CONCLUSION: The study concludes that effective measures should be taken to improve the overall awareness not only among patients but also among different stakeholders in the healthcare delivery system. Readability of the patients' rights charter with good readability score, developing and distributing patient education materials in simple language about the rights and responsibilities to the patient and their family/relatives during their stay in the hospital or at the time of registration.Continuing nursing and medical education in medical teaching institutions and hospitals should focus on patients' rights and its importance, its need for awareness and its consequences should be taught to students and hospital staff. Patient Right Committee in the hospital should be established for supervision monitoring and observance of patients' rights.